Guillain-Barré syndrome mimicking brain death pattern: a poorly reversible condition

A 73-year-old man developed a fulminant form of Guillain-Barrd syndrome with abolition of brainstem reflexes. Antibodies to GQ1b were positive (1:180). The clinical findings mimicked a "brain death" pattern for a period of 12 days. In contrast, the EEG showed remaining cerebral electrical activity. Brainstem auditory evoked potentials, long-latency auditory potentials and flash-evoked visual potentials were normal. However, no peripheral and cortical somatosensory evoked potentials could be elicited. Accordingly, nerve conduction studies were indicative of motor and sensory axonal neuropathy. After 5 months, the patient had no apparent cognitive deficit but was still quadriplegic and dependent from the mechanical ventilation. He died on day 158 from nosocomial infection, without motor recovery. Other published cases with a similar admission pattern were reviewed. The prognosis is usually very poor; as most of the patients died or remained severely disabled.